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Time running out on the MDGs

Students of Had Ane Primary School wash their hands under a running tap in Laos, where they are taught the importance of proper hand washing and drinking safe water. Goals on access to water has been achieved, but goals for sanitation are among the most off-track. Photo by: Bart Verweij / World Bank / CC BY-NC-ND

The eight international goals established by the United Nations in 2000, and designed to improve the lives of the world’s poorest, are nearing their expiration date in 2015.

We won’t reach all of them, and the development community is now rocked with debate over where we have fallen short and, more importantly, what will replace them in a post-2015 framework.

In the area of health spending, the Millennium Development Goals have led to some notable successes. The three so-called health MDGs spurred important international efforts to tackle some of the major causes of ill health and made important strides in areas including malaria, HIV and vaccines.

The goal on access to water has been achieved, which is good news for health. But goals for sanitation are among the most off-track. Diarrhea, and its related illnesses, remains the third-largest killer of children under age five in sub-Saharan Africa, and almost 90 per cent of these cases are because of poor water, sanitation and hygiene.

The Action for Global Health – Child Health working group — which WaterAid is a member of — published a paper last month on how to maximize integrated approaches in dealing with child health. The document shows that the adoption of separate targets on, among others, nutrition, water and sanitation led to a fragmented response to public health challenges. Efforts address specific diseases or health issues, rather than overall health needs.

That means if you have a program focused solely on preventing and treating malaria, it cannot then respond to children’s other health needs, including vulnerability to pneumonia, diarrhea and undernutrition.

The post-2015 development framework — if it is to tackle the remaining challenges of health — must better reflect the complex links between poverty and ill health. The indicators and programs that come out of this framework should be more integrated in nature, with individuals, not diseases, as their starting point, and the ability to respond to health needs throughout their lives.

The question is, how can we get it right next time?

First, we need to get the framework right. We need to set goals and targets that cut across sectors, such as maximising healthy life expectancy — a goal put forward earlier this year by the U.N. High-Level Panel on Post-2015.

Such a goal allows us to break down unhelpful separation between targets like reducing child mortality and their determinants, for instance education, water and sanitation, nutrition and gender empowerment.

Pushing for universal health coverage — which incorporates the whole spectrum from preventative work on issues like environmental health and promotive efforts such as behavioral change, through curative, rehabilitative and palliative care — also generates an approach focusing on users of healthcare services, rather than focused on interventions alone. This allows further measures that can reach beyond the traditional remit of medical services.

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Second, we need to get our programs right, by building on the best practices of existing programmes. World Bank President Jim Kim spoke to the World Health Assembly earlier this year about a “diagonal” approach to health program design, crafting priority, disease-specific approaches that improve the wider health system.

A pilot program to test this type of integrated approach is being designed by Nepal’s Ministry of Health and Population and WaterAid to include hygiene promotion into routine immunization for rotavirus, as part of a comprehensive strategy to reduce diarrheal diseases in Nepal.

New approach

All this will require a fundamental change in the way health is addressed and the aid architecture that supports it. It requires health funders to spend not just on immediate medical interventions to prevent and treat disease, but also on addressing the causes.

Funders and managers alike will have to accommodate a longer-term view of value-for-money, looking at spending as investment, and assessing for longer-term impact, instead of short-term outputs. Importantly, global funders should promote country-led, rather than donor-driven, strategies to strengthen country ownership, and implement programmes that focus on local needs and priorities.

We all need to take a longer-term view of what constitutes good value for money in development spending. It simply isn’t enough to consider the immediate results in isolation.

If the post-2015 framework is to achieve greater success in the area of improving global health, we must keep our eyes focused on long-term, big-picture impact.

Global health was one of the topics discussed at this year’s European Development Days. Check out our coverage of Europe’s leading global development event of the year.

About the author

Yael Velleman is senior policy analyst for health and sanitation at WaterAid. She is in charge of planning and leadership of the organization's global policy and advocacy on the role of water, sanitation and hygiene in human health and development.

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